Workshop Registration form

Course attending

If other: what course will you be attending?

Part 1: Student particulars (Please use BLOCK letters)

Student's full name(required)

Gender

Exam Pathway

School

Year level

Parent/Caregiver's Name(required)

Postal address

Residential address if different

Family email(required)

Main work email

Parent's Mobile number(required)

Student's Mobile number

Home number

Part 2: Any learning/health/attentional/behaviour issues. (Please leave blank if none)

Any food intolerances

Part 3: (Information particulars)

How did you find out about KTL tuition ?
 Friend/Work Colleague Who? School recommendation Brochure Internet Search Other
Please give us details about your selection

If you would like to receive Kidz Newz (1 x a term email newsletter, 2-3 pages)

Please read the Terms and Conditions carefully.

 I have read and agree to the Terms and Conditions. Please ask for clarification of any points you are unsure of. This document is issued on 19/01/13 and supersedes any previous terms and conditions issued by KTL Tuition formerly known as Kidz Therapy Ltd.